Blue Plus
Plan Name
2005
Reporting Year
Plan ID
Submission #
Title
General Info
Last Refreshed:
10/7/2009 10:56:59 AM
Page
Disclaimers
Effectiveness of
Care Measures
1
8
2
Measure
Page
Use of Services
Measures
Page
Measure
Childhood Immunization Status
3
Well-Child Visits In The First 15 Months of Life
28
Adolescent Immunization Status
5
Well-Child Visits In The Third, Fourth, Fifth And Sixth Year of Life
30
Appropriate Treatment of Children w/ Upper Respiratory Infection
7
Adolescent Well-Care Visits
31
Colorectal Cancer Screening
9
Frequency of Selected Procedures
32
Breast Cancer Screening
10
Inpatient Utilization - General Hospital/Acute Care
34
Cervical Cancer Screening
11
Ambulatory Care
37
Chlamydia Screening in Women
12
Inpatient Utilization - Nonacute Care
39
Controlling High Blood Pressure
13
Mental Health Utilization - Inpatient Discharges and Average Length of Stay
42
Beta Blocker Treatment after a Heart Attack
14
Mental Health Utilization - % of Members Receiving Inpatient and Ambulatory Services
45
Persistence of Beta Blocker Treatment after a Heart Attack
14
Chemical Dependency Utilization - Inpatient Discharges and Average Length of Stay
49
Cholesterol Management for Patients with Cardiovascular Conditions
15
Identification of Alcohol and Other Drug Services
52
Comprehensive Diabetes Care
16
Outpatient Drug Utilization
56
Use of Appropriate Medications for People with Asthma
20
Antidepressant Medication Management
26
Osteoporosis Management in Women who had a Fracture
27
Glaucoma Screening in Older Adults
27
Access /
Availability of
Care
Measure
Measure
Page
Practitioner Turnover
69
Years in Business / Total Membership
70
Page
Adults' Access to Preventive/Ambulatory Health Services
58
Children's Access to Primary Care Practitioners
62
Prenatal and Postpartum Care
64
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
66
HEDIS 2006 (Reporting Year 2005)
Health Plan
Stability
Health Plan
Descriptive
Information
Measure
Enrollment by Product Line (Age & Sex)
Page
71
DISCLAIMERS
-1
0. Disclaimer Query located below
1. In October 2009, it was discoverd that the formulas in the Inpatient Utilization: General
Hospital/Acute Care measure contained error. The formula was fixed and the data displayed now
correctly reflects the rest of the data on the sheet.
HEDIS 2006 (Reporting Year 2005)
Page 2
Effectiveness of Care
Blue Plus
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
HiB
Hepatitis B
VZV
Combo 3
1253
61.63%
1391
68.42%
1979
97.34%
1465
72.06%
1341
65.96%
1831
90.06%
691
33.99%
969
47.66%
537
26.41%
287
66.44%
311
71.99%
377
87.27%
322
74.54%
298
68.98%
370
85.65%
180
41.67%
241
55.79%
149
34.49%
277
115
95.38%
93.23%
97.53%
298
94
95.38%
93.23%
97.53%
359
25
93.43%
90.91%
95.95%
308
67
91.24%
88.39%
94.10%
285
106
95.13%
92.93%
97.34%
354
20
91.00%
88.11%
93.89%
175
199
91.00%
88.11%
93.89%
234
110
83.70%
80.01%
87.39%
146
186
80.78%
76.85%
84.71%
432
1
Number of Records Excluded because of
Contraindications by Admin Data
0
Number of Records Excluded because of
Contraindications by Medical Record
Review
1
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
2
HEDIS 2006 (Reporting Year 2005)
MMR
411
5.00%
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
IPV
2005
HO
S
2033
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Pneumococcal
Combo 2
Conjugate
DTaP/DT
411
Page 3
Effectiveness of Care
Blue Plus
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicaid
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
HiB
Hepatitis B
VZV
Combo 3
1253
53.87%
1391
59.80%
1979
85.08%
1465
62.98%
1341
57.65%
1831
78.72%
691
29.71%
969
41.66%
537
23.09%
233
53.94%
251
58.10%
372
86.11%
279
64.58%
239
55.32%
347
80.32%
129
29.86%
183
42.36%
104
24.07%
222
159
92.70%
90.06%
95.34%
237
145
92.94%
90.35%
95.54%
356
23
92.21%
89.50%
94.93%
265
93
87.10%
83.74%
90.47%
226
155
92.70%
90.06%
95.34%
331
24
86.37%
82.94%
89.81%
124
238
88.08%
84.82%
91.33%
173
156
80.05%
76.06%
84.03%
100
215
76.64%
72.43%
80.85%
432
0
Number of Records Excluded because of
Contraindications by Admin Data
0
Number of Records Excluded because of
Contraindications by Medical Record
Review
2
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
2
HEDIS 2006 (Reporting Year 2005)
MMR
411
5.00%
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
IPV
2005
HO
S
2326
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Pneumococcal
Combo 2
Conjugate
DTaP/DT
411
Page 4
Effectiveness of Care
Blue Plus
Adolescent Immunization Status
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
Combo 2
1088
39.49%
367
13.32%
160
5.81%
29
1.05%
169
39.12%
54
12.50%
31
7.18%
3
0.69%
165
159
78.83%
74.76%
82.90%
52
200
61.31%
56.48%
66.14%
26
175
48.91%
43.95%
53.86%
3
153
37.96%
33.14%
42.77%
432
0
Number of Records Excluded because of
Contraindications by Admin Data
0
Number of Records Excluded because of
Contraindications by Medical Record Review
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
HEDIS 2006 (Reporting Year 2005)
VZV
411
5.00%
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
Hepatitis B
2005
HO
S
2755
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
MMR
411
Page 5
Effectiveness of Care
Blue Plus
Adolescent Immunization Status
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicaid
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
Combo 2
766
27.80%
307
11.14%
202
7.33%
26
0.94%
152
35.19%
71
16.44%
39
9.03%
8
1.85%
142
139
68.37%
63.75%
72.99%
67
162
55.72%
50.79%
60.64%
37
132
41.12%
36.24%
46.00%
6
125
31.87%
27.25%
36.50%
432
0
Number of Records Excluded because of
Contraindications by Admin Data
0
Number of Records Excluded because of
Contraindications by Medical Record Review
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
HEDIS 2006 (Reporting Year 2005)
VZV
411
5.00%
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
Hepatitis B
2005
HO
S
2755
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
MMR
411
Page 6
Effectiveness of Care
Blue Plus
Appropriate Treatment for Children with Upper
Respiratory Infection
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
General
Measure
Data
2005
A
Eligible Member Population
3005
Numerator Events by Admin Data
499
Reported Rate
83.39%
Lower 95% Confidence Interval
82.05%
Upper 95% Confidence Interval
84.74%
HEDIS 2006 (Reporting Year 2005)
Page 7
Effectiveness of Care
Blue Plus
Colorectal Cancer Screening
Data Elements
Measurement Year
Data collection methodology (administrative or hybrid)
Sampling method used (see User's Guide for entry descriptions)
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
NR
NR
NR
S
Number of numerator events by administrative data in eligible
population (before exclusions)
19490
48.69%
Minimum required sample size (MRSS) or other sample size
398
Oversampling rate
0.1
Final sample size (FSS)
438
Number of numerator events by administrative data in FSS
203
Number of original sample records excluded because of valid data
errors
Records Excluded because of contraindications through Admin
Data
Records Excluded because of contraindications through Medical
Record Review
NR
HO
40028
Administrative rate on FSS
MSHO
2005
Eligible population
Current year's administrative rate (before exclusions)
Medicare
Advantage
46.35%
0
0
0
Number of employee/dependent medical records excluded
0
Records added from the oversample list
0
Denominator
398
Numerator events by administrative data
179
FOBT by administrative data*
DCBE by administrative data*
Numerator events by medical records
23
Flexible sigmoidoscopy by medical records*
DCBE by medical records*
Colonoscopy by medical records*
Reported rate
50.75%
NR
NR
Lower 95% confidence interval
45.72%
NR
NR
Upper 95% confidence interval
55.79%
NR
NR
Data Elements with an Asterisk(*) are OPTIONAL and are not used in any calculation or total
HEDIS 2006 (Reporting Year 2005)
Page 8
Effectiveness of Care
Blue Plus
Breast Cancer Screening
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
2005
A
18262
13771
75.41%
74.78%
76.04%
Medicare
Advantage
NR
NR
NR
Medicaid
2005
A
2746
1615
58.81%
56.95%
60.67%
Page 9
Effectiveness of Care
Blue Plus
Cervical Cancer Screening
Data Elements
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Medicaid
2005
HO
S
47011
2005
HO
S
19780
36620
14443
77.90%
260
10.00%
286
226
79.02%
5
73.02%
321
10.00%
353
242
68.56%
0
Records Excluded because of contraindications
through Admin Data
0
1
Records Excluded because of contraindications
through Medical Record Review
0
3
Number of employee/dependent medical records
excluded
0
0
5
260
209
5
82.31%
77.48%
87.14%
4
321
245
11
79.75%
75.20%
84.30%
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
Records Excluded because of Valid Data Errors
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 10
Effectiveness of Care
Blue Plus
Chlamydia Screening in Women
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
General
Measure Ages 16-20 Ages 21-25
Data
Medicaid
Total
2005
A
General
Measure Ages 16-20 Ages 21-25
Data
Total
2005
A
3222
804
24.95%
23.44%
26.46%
3078
839
27.26%
25.67%
28.85%
6300
1643
26.08%
24.99%
27.17%
2265
664
29.32%
27.42%
31.21%
3045
930
30.54%
28.89%
32.19%
5310
1594
30.02%
28.78%
31.26%
Page 11
Effectiveness of Care
Blue Plus
Controlling High Blood Pressure
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Data Elements
Measurement Year
Data Collection Methodology (Hybrid)
Sampling Method Used
Eligible Member Population
Numerator Events by Admin Data on
Eligible Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Commercial
2004
HO
S
8557
0
0.00%
16.96%
462
0
0.00%
27
Records Excluded because of
contraindications through Admin Data
0
Records Excluded because of
contraindications through Medical Record
Review
0
Number of employee/dependent medical
records excluded
0
Records Added from the OverSample List
27
Denominator
395
Numerator Events by Medical Record
NR
395
Records Excluded because of Valid Data
Errors
Numerator Events by Admin Data
Medicare Advantage
NR
0
277
Reported Rate
70.13%
NR
Lower 95% Confidence Interval
65.49%
NR
Upper 95% Confidence Interval
74.77%
NR
HEDIS 2006 (Reporting Year 2005)
Page 12
Effectiveness of Care
Blue Plus
Beta Blocker Treatment after Heart Attack
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
116
77.85%
NR
NR
100
10.00%
Final Sample Size (FSS)
110
Numerator events by admin data in FSS
89
Admin rate on FSS
NR
S
Numerator Events by Admin Data on
Eligible Population
Oversampling Rate
NR
HO
149
Minimum Required Sample Size
MSHO
2005
Eligible Member Population
Current Year's Admin Rate
Medicare Advantage
80.91%
Records Excluded because of Valid Data
Errors
1
Records Excluded because of
contraindications through Admin Data
0
Records Excluded because of
contraindications through Medical Record
Review
0
Number of employee/dependent medical
records excluded
0
Records Added from the Oversample List
1
Denominator
100
Numerator Events by Admin Data
81
Numerator Events by Medical Record
13
Reported Rate
94.00%
NR
NR
Lower 95% Confidence Interval
88.85%
NR
NR
Upper 95% Confidence Interval
99.15%
NR
NR
HEDIS 2006 (Reporting Year 2005)
Page 13
Effectiveness of Care
Blue Plus
Persistence of Beta Blocker Treatment After Hearth Attack
Data Elements
Measurement Year
Commercial
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
MSHO
2005
Data Collection Methodology
A
Eligible Member Population
93
Numerator Events by Admin Data on
Eligible Population
68
Reported Rate
73.12%
NR
NR
Lower 95% Confidence Interval
63.57%
NR
NR
Upper 95% Confidence Interval
82.67%
NR
NR
HEDIS 2006 (Reporting Year 2005)
Page 14
Effectiveness of Care
Blue Plus
Cholesterol Management for
Patients with Cardiovascular
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
58
Records Excluded because of contraindications
through Admin Data
0
Records Excluded because of contraindications
through Medical Record Review
0
Number of employee/dependent medical
records excluded
0
HEDIS 2006 (Reporting Year 2005)
LDL-C
screening
LDL-C Level of LDL-C Level of
<100 mg/dL
<130 mg/dL
1807
0
0
78.53%
0.00%
0.00%
268
0
0
54.69%
0.00%
0.00%
234
83
0
160
0
219
77.13%
72.95%
81.31%
38.93%
34.09%
43.77%
53.28%
48.34%
58.23%
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
411
19.22%
490
Records Excluded because of Valid Data Errors
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
General
LDL-C Level of LDL-C Level of
Measure
<100 mg/dL
<130 mg/dL
Data
2005
HO
S
2301
Numerator Events by Admin Data on Eligible
Population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
LDL-C
screening
Medicare Advantage
58
411
Page 15
Effectiveness of Care
Blue Plus
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
HbA1c
Testing
Poor HbA1c
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<130 mg/dL
LDL-C Level
<100 mg/dL
Monitoring for
Diabetic
Nephropathy
2004
HO
S
6594
2004
HO
S
6594
2005
HO
S
6103
2004
HO
S
6594
2004
HO
S
6594
2004
HO
S
6594
2005
HO
S
6103
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
5650
85.68%
411
15%
471
419
88.96%
0
0.00%
411
15%
471
0
0.00%
3391
55.56%
411
10%
453
228
50.33%
5811
88.13%
411
15%
471
431
91.51%
0
0.00%
411
15%
471
0
0.00%
0
0.00%
411
15%
471
0
0.00%
3577
58.61%
411
10%
453
278
61.37%
Number of Records Excluded Because of
Valid Data Errors
0
0
0
0
0
0
0
Records Excluded because of
contraindications through Admin Data
0
0
0
0
0
0
0
Records Excluded because of
contraindications through Medical Record
Review
3
3
0
3
3
3
0
Number of employee/dependent medical
records excluded
0
0
0
0
0
0
0
3
411
351
32
93.19%
90.63%
95.74%
3
411
0
85
20.68%
16.64%
24.72%
0
411
212
28
58.39%
53.51%
63.28%
0
411
375
25
97.32%
95.64%
99.01%
0
411
0
276
67.15%
62.49%
71.82%
0
411
0
144
35.04%
30.30%
39.77%
0
411
247
10
62.53%
57.73%
67.33%
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 16
Effectiveness of Care
Blue Plus
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
Data Elements
HbA1c
Testing
Poor HbA1c
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<130 mg/dL
LDL-C Level
<100 mg/dL
Monitoring for
Diabetic
Nephropathy
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Records Excluded because of
contraindications through Admin Data
Records Excluded because of
contraindications through Medical Record
Review
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 17
Effectiveness of Care
Blue Plus
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 10:56 AM
MSHO
Data Elements
HbA1c
Testing
Poor HbA1c
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<130 mg/dL
LDL-C Level
<100 mg/dL
Monitoring for
Diabetic
Nephropathy
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Records Excluded because of
contraindications through Admin Data
Records Excluded because of
contraindications through Medical Record
Review
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 18
Effectiveness of Care
Blue Plus
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicaid
HbA1c
Testing
Poor HbA1c
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<130 mg/dL
LDL-C Level
<100 mg/dL
Monitoring for
Diabetic
Nephropathy
2004
HO
S
2232
2004
HO
S
2232
2004
HO
S
2232
2004
HO
S
2232
2004
HO
S
2232
2004
HO
S
2232
2005
HO
S
2361
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
1838
82.35%
411
14%
470
403
85.74%
0
0.00%
411
14%
470
0
0.00%
1061
47.54%
411
14%
470
252
53.62%
1784
79.93%
411
14%
470
387
82.34%
0
0.00%
411
14%
470
0
0.00%
0
0.00%
411
14%
470
0
0.00%
1316
55.74%
411
10%
452
244
53.98%
Number of Records Excluded Because of
Valid Data Errors
0
0
0
0
0
0
0
Records Excluded because of
contraindications through Admin Data
0
0
0
0
0
0
0
Records Excluded because of
contraindications through Medical Record
Review
4
4
4
4
4
4
1
Number of employee/dependent medical
records excluded
0
0
0
0
0
0
0
4
411
344
22
89.05%
85.91%
92.19%
4
411
0
123
29.93%
25.38%
34.48%
4
411
222
26
60.34%
55.49%
65.19%
4
411
332
24
86.62%
83.20%
90.03%
4
411
0
214
52.07%
47.12%
57.02%
4
411
0
139
33.82%
29.12%
38.52%
1
411
244
11
62.04%
57.23%
66.86%
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 19
Effectiveness of Care
Blue Plus
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
General
Measure Data
Ages 5-9
Ages 10-17
Ages 18-56
Total
224
222
99.11%
97.65%
100.00%
372
360
96.77%
94.84%
98.70%
1621
1525
94.08%
92.90%
95.26%
2217
2107
95.04%
94.11%
95.96%
2005
A
Page 20
Effectiveness of Care
Blue Plus
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicaid
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
General
Measure Data
Ages 5-9
Ages 10-17
Ages 18-56
Total
240
237
98.75%
97.14%
100.00%
398
378
94.97%
92.70%
97.25%
760
684
90.00%
87.80%
92.20%
1398
1299
92.92%
91.54%
94.30%
2005
A
Page 21
Effectiveness of Care
Blue Plus
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
142
11.94%
10.06%
13.83%
840
70.65%
68.02%
73.28%
633
53.24%
50.36%
56.12%
2005
A
1189
Page 22
Effectiveness of Care
Blue Plus
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 23
Effectiveness of Care
Blue Plus
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 10:56 AM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 24
Effectiveness of Care
Blue Plus
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicaid
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
90
10.49%
8.38%
12.60%
448
52.21%
48.81%
55.62%
316
36.83%
33.54%
40.12%
2005
A
858
Page 25
Effectiveness of Care
Blue Plus
Osteoporosis Management in
Women Who had a Fracture
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interva
HEDIS 2006 (Reporting Year 2005)
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare
Advantage
MSHO
NR
NR
NR
NR
NR
NR
Page 26
Effectiveness of Care
Blue Plus
Glaucoma Screening in Older Adults
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Total Exclusions
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interva
HEDIS 2006 (Reporting Year 2005)
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare
Advantage
MSHO
NR
NR
NR
NR
NR
NR
Page 27
Use of Services
Blue Plus
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
Zero Visits
1 visit
2 visits
3 visits
4 visits
5 visits
6 or more
visits
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
38
8
19
36
100
316
1315
2.07%
1.39%
2.75%
0.44%
0.11%
0.77%
1.04%
0.55%
1.53%
1.97%
1.30%
2.63%
5.46%
4.39%
6.53%
17.25%
15.49%
19.01%
71.78%
69.69%
73.87%
2005
A
1832
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of records excluded because of
contraindications identified through
administrative data
Number of records excluded because of
contraindications identified through medical
record review
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 28
Use of Services
Blue Plus
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicaid
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
Zero Visits
1 visit
2 visits
3 visits
4 visits
5 visits
6 or more
visits
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
72
67
111
268
569
940
284
3.12%
2.39%
3.85%
2.90%
2.19%
3.60%
4.80%
3.91%
5.70%
11.60%
10.27%
12.92%
24.62%
22.84%
26.40%
40.68%
38.65%
42.70%
12.29%
10.93%
13.65%
2005
A
2311
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of records excluded because of
contraindications identified through
administrative data
Number of records excluded because of
contraindications identified through medical
record review
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 29
Use of Services
Blue Plus
Well Child Visits in the 3rd, 4th,
5th and 6th Years of Life
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Medicaid
2005
A
2005
A
8564
7919
NR
NR
NR
NR
4887
4301
57.06%
56.01%
58.12%
54.31%
53.21%
55.42%
Numerator events by admin data in eligible
population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Records Excluded because of Valid Data Errors
Records Excluded - Contraindications/Admin Data
Records Excluded - Contraindications/Medical
Record Review
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 30
Use of Services
Blue Plus
Adolescent Well-Care Visits
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Medicaid
2005
A
2005
A
27686
17566
NR
NR
NR
NR
8249
5049
29.79%
29.25%
30.34%
28.74%
28.07%
29.42%
Numerator events by admin data in eligible
population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Records Excluded because of Valid Data Errors
Records Excluded - Contraindications/Admin Data
Records Excluded - Contraindications/Medical
Record Review
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 31
Use of Services
Blue Plus
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Measurement Year
2005
Member Months
Total
142480
301902
544538
385116
Age
0-4
0-9
5-19
10-19
Total
Procedure
Myringotomy
Tonsillectomy
Age
15-44
20-44
30-64
45-64
65+
Age
0-4
5-19
0-9
10-19
Number of
Procedures
451
106
266
146
Procedures /
1,000 Member
Months
3.17
0.19
0.88
0.38
Member Months
Male
Female
522580
359967
423573
631512
384824
417281
14395
8872
Male
Procedure
Age
Dilation & Curettage 15-44
45-64
Hysterectomy,
15-44
Abdominal
45-64
65+
Hysterectomy,
15-44
Vaginal
45-64
65+
Cholecystectomy,
30-64
Open
15-44
45-64
65+
Cholecystectomy,
30-64
Closed
15-44
45-64
65+
Back Surgery
20-44
45-64
Angioplasty (PTCA) 45-64
65+
Cardiac
45-64
Catheterization
65+
CABG
45-64
65+
Prostatectomy
45-64
65+
Mastectomy
15-44
45-64
65+
Lumpectomy
15-44
45-64
65+
HEDIS 2006 (Reporting Year 2005)
Number of
Procedures
24
2
117
8
83
172
192
21
322
31
65
8
111
11
Female
Procedures /
1,000 Member
Months
Number of
Procedures
22
51
108
174
2
109
150
3
Procedures /
1,000 Member
Months
0.04
0.12
0.21
0.42
0.23
0.21
0.36
0.34
0.04
0.14
0.19
0.56
0.23
0.45
0.50
1.46
0.84
2.15
0.17
0.56
0.29
0.76
17
21
0
0.03
0.05
0.00
228
183
4
80
170
48
4
163
7
13
0
0.44
0.44
0.45
0.19
0.41
0.12
0.45
0.39
0.79
0.03
0.00
20
59
1
95
192
4
0.04
0.14
0.11
0.18
0.46
0.45
Page 32
Use of Services
Blue Plus
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
Measurement Year
Age
< 65
65-74
75-84
85+
Member Months
Male
Female
Male
Procedure
CABG
Angioplasty
(PTCA)
Cardiac
Catheterization
Carotid
Endarterectomy
Reduction of
Fracture of Femur
Total Hip
Replacement
Total Knee
Replacement
Partial Excision of
Large Inestine
Cholecystectomy,
Open
Cholecystectomy,
Closed
(laparoscopic)
Hysterectomy
Abdominal
Hysterectomy,
Vaginal
Prostatectomy
Mastectomy
Lumpectomy
Age
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
HEDIS 2006 (Reporting Year 2005)
Number of
Procedures
Female
Procedures /
1,000 Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number of
Procedures
Procedures /
1,000 Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 33
Use of Services
Blue Plus
Inpatient Utilization - General Hospital/Acute Care
Commercial
Measurement
Year
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
65-74
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 10:56 AM
2005
Member Months
27442
274460
385116
783540
802105
21829
1285
153
0
2295930
Discharges
Discharges /
1,000 Member
Months
334
476
695
4845
5945
391
22
3
0
12711
12.17
1.73
1.80
6.18
7.41
17.91
17.12
19.61
272
344
334
903
2708
198
17
2
0
4778
9.91
1.25
0.87
1.15
3.38
9.07
13.23
13.07
62
132
268
1365
3235
193
5
1
0
5261
2.26
0.48
0.70
1.74
4.03
8.84
3.89
6.54
93
2577
2
0
0
2672
0.24
3.29
0.00
0.00
HEDIS 2006 (Reporting Year 2005)
5.54
2.08
2.29
1.34
Days
2555
1245
2405
13314
21115
1895
72
9
0
42610
Days / 1,000
Member
Months
93.11
4.54
6.24
16.99
26.32
86.81
56.03
58.82
18.56
1781
772
994
2451
8182
763
51
4
0
14998
64.90
2.81
2.58
3.13
10.20
34.95
39.69
26.14
774
473
1178
4347
12926
1132
21
5
0
20856
28.20
1.72
3.06
5.55
16.12
51.86
16.34
32.68
233
6516
7
0
0
6756
0.61
8.32
0.01
0.00
6.53
9.08
3.39
Average
Length of Stay
7.65
2.62
3.46
2.75
3.55
4.85
3.27
3.00
NA
3.35
6.55
2.24
2.98
2.71
3.02
3.85
3.00
2.00
NA
3.14
12.48
3.58
4.40
3.18
4.00
5.87
4.20
5.00
NA
3.96
2.51
2.53
3.50
NA
NA
2.53
Page 34
Use of Services
Blue Plus
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
Measurement
Year
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
65-74
Unknown
Total
Member Months
NR
Discharges
Discharges /
1,000 Member
Months
Days
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Days / 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
Average
Length of Stay
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 35
Use of Services
Blue Plus
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 7, 2009 10:56 AM
MSHO
Measurement
Year
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
65-74
Unknown
Total
Member Months
NR
Discharges
Discharges /
1,000 Member
Months
Days
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Days / 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
Average
Length of Stay
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 36
Use of Services
Blue Plus
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Measurement
Year
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
2005
Member
Months
27442
274460
385116
783540
802105
21829
1285
153
0
2295930
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
23222
76537
79233
190579
269779
10951
861
65
0
651227
HEDIS 2006 (Reporting Year 2005)
Visits/ 1,000
Member
Months
846.22
278.86
205.74
243.23
336.34
501.67
670.04
424.84
283.64
Emergency Room Visits
Visits
891
4532
4769
9774
8317
302
32
2
0
28619
Visits/ 1,000
Member
Months
32.47
16.51
12.38
12.47
10.37
13.83
24.90
13.07
12.47
Ambulatory
Surgery/Procedures
Procedures
191
1258
1080
5167
13762
554
44
2
0
22058
Procedures/
1,000 Member
Months
6.96
4.58
2.80
6.59
17.16
25.38
34.24
13.07
9.61
Observation Room Stays
Resulting in Discharge
Stays
29
110
141
1047
638
23
1
0
0
1989
Stays/ 1,000
Member
Months
1.06
0.40
0.37
1.34
0.80
1.05
0.78
0.00
0.87
Page 37
Use of Services
Blue Plus
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
Measurement
Year
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
NR
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
NR
HEDIS 2006 (Reporting Year 2005)
Visits/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Emergency Room Visits
Visits
NR
Visits/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Ambulatory
Surgery/Procedures
Procedures
NR
Procedures/
1,000 Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Observation Room Stays
Resulting in Discharge
Stays
NR
Stays/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 38
Use of Services
Blue Plus
Inpatient Utilization - Nonacute Care
Commercial
Measurement
Year
Age
2005
Member
Months
<1
27442
1-9
274460
10-19
385116
20-44
783540
45-64
802105
65-74
21829
75-84
1285
85+
153
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 10:56 AM
0
2295930
Discharges
Discharges /
1,000 Member
Months
Days
Days / 1,000
Member
Months
<1
0
0.00
0
0.00
NA
1-9
1
0.00
8
0.03
8.00
10-19
6
0.02
70
0.18
11.67
20-44
22
0.03
228
0.29
10.36
45-64
343
0.43
4877
6.08
14.22
65-74
62
2.84
831
38.07
13.40
75-84
5
3.89
71
55.25
14.20
85+
1
6.54
14
91.50
14.00
0.19
0
6099
2.66
NA
13.86
Age
Unknown
Total
0
440
HEDIS 2006 (Reporting Year 2005)
Average Length
of Stay
Page 39
Use of Services
Blue Plus
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
Measurement
Year
Age
Member
Months
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
NR
Discharges
Discharges /
1,000 Member
Months
Days
Days / 1,000
Member
Months
Average Length
of Stay
<1
NR
NR
NR
1-9
NR
NR
NR
10-19
NR
NR
NR
20-44
NR
NR
NR
45-64
NR
NR
NR
65-74
NR
NR
NR
75-84
NR
NR
NR
85+
NR
NR
NR
NR
NR
NR
Unknown
Total
NR
HEDIS 2006 (Reporting Year 2005)
NR
NR
Page 40
Use of Services
Blue Plus
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 10:56 AM
MSHO
Measurement
Year
Age
Member
Months
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
NR
Discharges
Discharges /
1,000 Member
Months
Days
Days / 1,000
Member
Months
Average Length
of Stay
<1
NR
NR
NR
1-9
NR
NR
NR
10-19
NR
NR
NR
20-44
NR
NR
NR
45-64
NR
NR
NR
65-74
NR
NR
NR
75-84
NR
NR
NR
85+
NR
NR
NR
NR
NR
NR
Unknown
Total
NR
HEDIS 2006 (Reporting Year 2005)
NR
NR
Page 41
Use of Services
Blue Plus
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Commercial
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 10:56 AM
2005
Male
Member Months
Female
Total
210783
103886
783231
14395
0
1112295
196354
99466
878943
8872
0
1183635
407137
203352
1662174
23267
0
2295930
Discharges
Discharges /
1,000 Member
Months
Age
0-12
Days*
Average
Length of Stay
Gender
M
36
0.17
659
18.31
F
9
0.05
88
9.78
Total
45
0.11
747
16.60
M
13-17
100
0.96
1685
16.85
F
125
1.26
1746
13.97
Total
225
1.11
3431
15.25
M
18-64
186
0.24
1315
7.07
F
263
0.30
1929
7.33
Total
449
0.27
3244
7.22
65+
M
1
0.07
13
13.00
F
0
0.00
0
NA
Total
1
0.04
13
13.00
Unknown
M
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
323
0.29
3672
11.37
F
397
0.34
3763
9.48
TOTAL
720
0.31
7435
10.33
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 42
Use of Services
Blue Plus
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
Discharges /
1,000 Member
Months
Days*
Average
Length of Stay
Gender
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
13-17
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
18-64
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
65+
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
Unknown
NR
F
NR
Total
NR
NR
NR
Total
M
NR
NR
NR
NR
F
NR
NR
NR
NR
TOTAL
NR
NR
NR
NR
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 43
Use of Services
Blue Plus
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Oct 7, 2009 10:56 AM
MSHO
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
Discharges /
1,000 Member
Months
Days*
Average
Length of Stay
Gender
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
13-17
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
18-64
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
65+
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
Unknown
M
NR
F
NR
Total
NR
NR
NR
Total
M
NR
NR
NR
NR
F
NR
NR
NR
NR
TOTAL
NR
NR
NR
NR
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 44
Use of Services
Blue Plus
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Measurement Year
2005
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
0-12
Member Months (Ambulatory)
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
210783
103886
196354
99466
407137
203352
210783
103886
196354
99466
407137
203352
210783
103886
196354
99466
407137
203352
210783
103886
196354
99466
407137
203352
783231
14395
0
1112295
878943
8872
0
1183635
1662174
23267
0
2295930
783231
14395
0
1112295
878943
8872
0
1183635
1662174
23267
0
2295930
783231
14395
0
1112295
878943
8872
0
1183635
1662174
23267
0
2295930
783231
14395
0
1112295
878943
8872
0
1183635
1662174
23267
0
2295930
Sex
M
F
Total
13-17
M
F
Total
18-64
M
F
Total
65+
M
F
Total
Unknown
M
F
Total
M
F
Total
Total
Member Months (Day/Night)
Female
Any Mental Health Services
Age
Member Months (Inpatient)
Male
Number
Percent
Inpatient Mental Health Services
Percent
Number
Day/Night Mental Health Services
Percent
Number
Ambulatory Mental Health Services
Percent
Number
1061
601
1662
1019
1121
2140
3999
7728
11727
29
21
50
0
0
0
6108
9471
15579
6.04%
3.67%
4.90%
11.77%
13.52%
12.63%
6.13%
10.55%
8.47%
2.42%
2.84%
2.58%
NA
NA
NA
6.59%
9.60%
8.14%
15
8
23
58
74
132
150
211
361
1
0
1
0
0
0
224
293
517
7
5
12
28
41
69
35
87
122
0
0
0
0
0
0
70
133
203
1058
599
1657
1013
1111
2124
3975
7694
11669
29
21
50
0
0
0
6075
9425
15500
HEDIS 2006 (Reporting Year 2005)
0.09%
0.05%
0.07%
0.67%
0.89%
0.78%
0.23%
0.29%
0.26%
0.08%
0.00%
0.05%
NA
NA
NA
0.24%
0.30%
0.27%
0.04%
0.03%
0.04%
0.32%
0.49%
0.41%
0.05%
0.12%
0.09%
0.00%
0.00%
0.00%
NA
NA
NA
0.08%
0.13%
0.11%
6.02%
3.66%
4.88%
11.70%
13.40%
12.53%
6.09%
10.50%
8.42%
2.42%
2.84%
2.58%
NA
NA
NA
6.55%
9.56%
8.10%
Page 45
Use of Services
Blue Plus
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
Measurement Year
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
Female
NR
Member Months (Inpatient)
Total
0-12
Sex
M
F
Total
Number
NR
13-17
M
F
Total
NR
18-64
M
F
Total
NR
65+
M
F
Total
NR
Unknown
M
F
Total
M
F
Total
NR
NR
NR
NR
Total
HEDIS 2006 (Reporting Year 2005)
Female
Total
Male
Female
Total
Member Months (Ambulatory)
Male
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Any Mental Health Services
Age
Male
Member Months (Day/Night)
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Mental Health Services
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Day/Night Mental Health Services
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Ambulatory Mental Health Services
Percent
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 46
Use of Services
Blue Plus
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 7, 2009 10:56 AM
MSHO
Measurement Year
Member Months (Any)
Age
Male
Female
0-12
13-17
18-64
65+
Unknown
Total
NR
NR
Member Months (Inpatient)
Total
0-12
Sex
M
F
Total
Number
NR
13-17
M
F
Total
NR
18-64
M
F
Total
NR
65+
M
F
Total
NR
Unknown
M
F
Total
M
F
Total
NR
NR
NR
NR
Total
HEDIS 2006 (Reporting Year 2005)
Female
Total
Male
Female
Total
Member Months (Ambulatory)
Male
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Any Mental Health Services
Age
Male
Member Months (Day/Night)
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Mental Health Services
Percent
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Day/Night Mental Health Services
Percent
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Ambulatory Mental Health Services
Percent
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 47
Use of Services
Blue Plus
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicaid
Measurement Year
2005
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
0-12
Member Months (Ambulatory)
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
247059
83677
501152
166977
254093
83300
247059
83677
501152
166977
254093
83300
247059
83677
501152
166977
254093
83300
247059
83677
501152
166977
248130
28369
0
613892
419689
78022
0
828447
667819
106391
0
1442339
248130
28369
0
613892
419689
78022
0
828447
667819
106391
0
1442339
248130
28369
0
613892
419689
78022
0
828447
667819
106391
0
1442339
248130
28369
0
613892
419689
78022
0
828447
667819
106391
0
1442339
Sex
M
F
Total
13-17
M
F
Total
18-64
M
F
Total
65+
M
F
Total
Unknown
M
F
Total
M
F
Total
Total
Member Months (Day/Night)
254093
83300
Any Mental Health Services
Age
Member Months (Inpatient)
Number
Percent
Inpatient Mental Health Services
Percent
Number
Day/Night Mental Health Services
Percent
Number
Ambulatory Mental Health Services
Percent
Number
2036
1339
3375
1243
1321
2564
2729
6498
9227
240
618
858
0
0
0
6248
9776
16024
9.62%
6.50%
8.08%
17.91%
18.94%
18.43%
13.20%
18.58%
16.58%
10.15%
9.51%
9.68%
NA
NA
NA
12.21%
14.16%
13.33%
44
24
68
83
148
231
233
365
598
24
53
77
0
0
0
384
590
974
14
4
18
26
37
63
22
79
101
3
19
22
0
0
0
65
139
204
2025
1336
3361
1233
1296
2529
2660
6427
9087
228
585
813
0
0
0
6146
9644
15790
HEDIS 2006 (Reporting Year 2005)
0.21%
0.12%
0.16%
1.20%
2.12%
1.66%
1.13%
1.04%
1.07%
1.02%
0.82%
0.87%
NA
NA
NA
0.75%
0.85%
0.81%
0.07%
0.02%
0.04%
0.37%
0.53%
0.45%
0.11%
0.23%
0.18%
0.13%
0.29%
0.25%
NA
NA
NA
0.13%
0.20%
0.17%
9.56%
6.49%
8.05%
17.76%
18.59%
18.17%
12.86%
18.38%
16.33%
9.64%
9.00%
9.17%
NA
NA
NA
12.01%
13.97%
13.14%
Page 48
Use of Services
Blue Plus
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Commercial
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 10:56 AM
2005
Male
Member Months
Female
Total
210783
103886
783231
14395
0
1112295
196354
99466
878943
8872
0
1183635
407137
203352
1662174
23267
0
2295930
Discharges
Discharges /
1,000 Member
Months
Age
0-12
Days
Average
Length of Stay
M
0
0.00
0
NA
F
0
0.00
0
NA
Total
0
0.00
0
NA
13-17
M
56
0.54
1346
24.04
F
50
0.50
722
14.44
Total
106
0.52
2068
19.51
18-64
M
258
0.33
3035
11.76
F
163
0.19
1844
11.31
Total
421
0.25
4879
11.59
65+
M
3
0.21
16
5.33
F
0
0.00
0
NA
Total
3
0.13
16
5.33
Unknown
M
0
0
NA
F
0
0
NA
Total
0
0
NA
M
Total
317
0.28
4397
13.87
F
213
0.18
2566
12.05
TOTAL
530
0.23
6963
13.14
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 49
Use of Services
Blue Plus
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
Discharges /
1,000 Member
Months
Days
Average
Length of Stay
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
13-17
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
18-64
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
65+
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
Unknown
NR
F
NR
Total
NR
NR
NR
Total
M
NR
NR
NR
NR
F
NR
NR
NR
NR
TOTAL
NR
NR
NR
NR
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 50
Use of Services
Blue Plus
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Oct 7, 2009 10:56 AM
MSHO
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
Discharges /
1,000 Member
Months
Days
Average
Length of Stay
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
13-17
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
18-64
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
65+
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
Unknown
M
NR
F
NR
Total
NR
NR
NR
Total
M
NR
NR
NR
NR
F
NR
NR
NR
NR
TOTAL
NR
NR
NR
NR
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 51
Use of Services
Blue Plus
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Measurement Year
2005
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
210783
103886
100054
117734
565443
14395
0
1112295
Female
196354
99466
110270
142203
626470
8872
0
1183635
Total
407137
203352
210324
259937
1191913
23267
0
2295930
Any Chemical Dependency
Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
2
5
7
197
137
334
258
138
396
183
96
279
767
449
1216
13
1
14
0
0
0
1420
826
2246
HEDIS 2006 (Reporting Year 2005)
Percent
0.01%
0.03%
0.02%
2.28%
1.65%
1.97%
NR
NR
NA
1.04%
0.59%
0.82%
1.63%
0.86%
1.22%
1.08%
0.14%
0.72%
NA
NA
NA
1.53%
0.84%
1.17%
Member Months (Inpatient)
Male
210783
103886
100054
117734
565443
14395
0
1112295
Female
196354
99466
110270
142203
626470
8872
0
1183635
Total
407137
203352
210324
259937
1191913
23267
0
2295930
Member Months (Day/Night)
Male
210783
103886
100054
117734
565443
14395
0
1112295
Female
196354
99466
110270
142203
626470
8872
0
1183635
Total
407137
203352
210324
259937
1191913
23267
0
2295930
Member Months (Ambulatory)
Male
210783
103886
100054
117734
565443
14395
0
1112295
Female
196354
99466
110270
142203
626470
8872
0
1183635
Total
407137
203352
210324
259937
1191913
23267
0
2295930
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
0
3
3
58
47
105
76
42
118
44
25
69
243
143
386
7
0
7
0
0
0
428
260
688
Number
0
0
0
9
11
20
4
9
13
6
7
13
21
15
36
0
0
0
0
0
0
40
42
82
Number
2
2
4
175
121
296
226
115
341
166
81
247
643
378
1021
7
1
8
0
0
0
1219
698
1917
Percent
0.00%
0.02%
0.01%
0.67%
0.57%
0.62%
NR
NR
NA
0.25%
0.15%
0.20%
0.52%
0.27%
0.39%
0.58%
0.00%
0.36%
NA
NA
NA
0.46%
0.26%
0.36%
Percent
0.00%
0.00%
0.00%
0.10%
0.13%
0.12%
NR
NR
NA
0.03%
0.04%
0.04%
0.04%
0.03%
0.04%
0.00%
0.00%
0.00%
NA
NA
NA
0.04%
0.04%
0.04%
Percent
0.01%
0.01%
0.01%
2.02%
1.46%
1.75%
NR
NR
NA
0.95%
0.50%
0.73%
1.36%
0.72%
1.03%
0.58%
0.14%
0.41%
NA
NA
NA
1.32%
0.71%
1.00%
Page 52
Use of Services
Blue Plus
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
Measurement Year
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Any Chemical Dependency
Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Inpatient)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Day/Night)
Member Months (Ambulatory)
Male
Female
Male
Female
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
Number
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 53
Use of Services
Blue Plus
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 10:56 AM
MSHO
Measurement Year
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Any Chemical Dependency
Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Inpatient)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Day/Night)
Member Months (Ambulatory)
Male
Female
Male
Female
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
Number
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 54
Use of Services
Blue Plus
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicaid
Measurement Year
2005
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
254093
83300
60742
53708
133680
28369
0
613892
Female
247059
83677
116180
110021
193488
78022
0
828447
Total
501152
166977
176922
163729
327168
106391
0
1442339
Any Chemical Dependency
Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
11
4
15
302
243
545
436
474
910
449
505
954
937
801
1738
65
63
128
0
0
0
2200
2090
4290
HEDIS 2006 (Reporting Year 2005)
Percent
0.05%
0.02%
0.04%
4.35%
3.48%
3.92%
NR
NR
NA
2.12%
2.45%
2.28%
8.41%
4.97%
6.37%
2.75%
0.97%
1.44%
NA
NA
NA
4.30%
3.03%
3.57%
Member Months (Inpatient)
Male
254093
83300
60742
53708
133680
28369
0
613892
Female
247059
83677
116180
110021
193488
78022
0
828447
Total
501152
166977
176922
163729
327168
106391
0
1442339
Member Months (Day/Night)
Male
254093
83300
60742
53708
133680
28369
0
613892
Female
247059
83677
116180
110021
193488
78022
0
828447
Total
501152
166977
176922
163729
327168
106391
0
1442339
Member Months (Ambulatory)
Male
254093
83300
60742
53708
133680
28369
0
613892
Female
247059
83677
116180
110021
193488
78022
0
828447
Total
501152
166977
176922
163729
327168
106391
0
1442339
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
4
1
5
119
102
221
140
159
299
158
160
318
329
296
625
38
36
74
0
0
0
788
754
1542
Number
0
0
0
16
16
32
17
9
26
14
19
33
17
19
36
2
1
3
0
0
0
66
64
130
Number
7
3
10
264
193
457
369
396
765
378
435
813
781
682
1463
35
32
67
0
0
0
1834
1741
3575
Percent
0.02%
0.00%
0.01%
1.71%
1.46%
1.59%
NR
NR
NA
0.75%
0.78%
0.76%
2.95%
1.84%
2.29%
1.61%
0.55%
0.83%
NA
NA
NA
1.54%
1.09%
1.28%
Percent
0.00%
0.00%
0.00%
0.23%
0.23%
0.23%
NR
NR
NA
0.07%
0.09%
0.08%
0.15%
0.12%
0.13%
0.08%
0.02%
0.03%
NA
NA
NA
0.13%
0.09%
0.11%
Percent
0.03%
0.01%
0.02%
3.80%
2.77%
3.28%
NR
NR
NA
1.79%
2.11%
1.95%
7.01%
4.23%
5.37%
1.48%
0.49%
0.76%
NA
NA
NA
3.58%
2.52%
2.97%
Page 55
Use of Services
Blue Plus
Outpatient Drug Utilization
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Measurement
Year
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
2005
Member Months
262937
342504
691391
705623
19249
1116
127
0
2022947
Total Cost of
Prescriptions
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
$4,543,396.47
$10,759,294.92
$30,087,630.96
$68,338,409.19
$2,840,326.85
$180,058.66
$11,077.46
$222.91
$116,760,417.42
HEDIS 2006 (Reporting Year 2005)
Avg. Cost of
Prescriptions /
Per Member Per
Month
$17.28
$31.41
$43.52
$96.85
$147.56
$161.34
$87.22
$57.72
Total Number of
Prescriptions
72492
118753
429679
980404
84680
22839
4105
28
1712980
Avg. Num. Of
Prescriptions /
Per Member Per
Year
3.31
4.16
7.46
16.67
52.79
245.58
387.87
10.16
Page 56
Use of Services
Blue Plus
Outpatient Drug Utilization
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
Measurement
Year
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
NR
Total Cost of
Prescriptions
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Avg. Cost of
Prescriptions /
Per Member Per
Month
Total Number of
Prescriptions
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
NR
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 57
Access/Availability of Care
Blue Plus
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Data Elements
General Measure
Data
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Ages 20-44
Ages 45-64
Ages 65+
37203
53678
1764
35220
51513
1695
94.67%
94.44%
94.90%
95.97%
95.80%
96.13%
96.09%
95.16%
97.02%
2005
A
Page 58
Access/Availability of Care
Blue Plus
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Page 59
Access/Availability of Care
Blue Plus
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 10:56 AM
MSHO
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Page 60
Access/Availability of Care
Blue Plus
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicaid
Data Elements
General Measure
Data
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Ages 20-44
Ages 45-64
Ages 65+
21499
10676
5835
2005
A
18134
9050
4677
84.35%
83.86%
84.84%
84.77%
84.08%
85.46%
80.15%
79.12%
81.19%
Page 61
Access/Availability of Care
Blue Plus
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Data Elements
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
General Measure
Data
12-24 months
25 months - 6
yrs.
7-11 yrs.
12-19 yrs.
2070
10468
10406
21076
2023
9336
9013
18756
97.73%
97.06%
98.40%
89.19%
88.59%
89.79%
86.61%
85.95%
87.27%
88.99%
88.57%
89.42%
2005
A
Page 62
Access/Availability of Care
Blue Plus
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicaid
Data Elements
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
General Measure
Data
12-24 months
25 months - 6
yrs.
7-11 yrs.
12-19 yrs.
3074
9874
7393
12184
2005
A
2996
8774
6487
10832
97.46%
96.89%
98.03%
88.86%
88.23%
89.49%
87.75%
86.99%
88.50%
88.90%
88.34%
89.47%
Page 63
Access/Availability of Care
Blue Plus
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
Timeliness of
Prenatal Care
Postpartum
Care
2004
HO
2004
HO
S
S
Eligible member population (i.e. members who meet all
denominator criteria)
2577
2577
Number of numerator events by administrative data in
eligible population (before exclusions)
909
1648
Current year's administrative rate (before exclusions)
Measurement Year
Data collection methodology (Administrative or Hybrid)
Sampling method used (see User's Guide for entry
descriptions)
35.27%
63.95%
Minimum required sample size (MRSS) or other sample
size
270
270
Oversampling rate
Final sample size (FSS)
5%
284
5%
284
Number of numerator events by administrative data in FSS
97
184
34.15%
64.79%
Number of original sample records excluded because of
valid data errors
1
1
Number of employee/dependent medical records
excluded
0
0
1
270
95
160
1
270
175
33
94.44%
91.53%
97.36%
77.04%
71.83%
82.24%
Administrative rate on FSS
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Page 64
Access/Availability of Care
Blue Plus
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicaid
Timeliness of
Prenatal Care
Postpartum
Care
2004
HO
2005
HO
S
S
Eligible member population (i.e. members who meet all
denominator criteria)
3595
3705
Number of numerator events by administrative data in
eligible population (before exclusions)
692
2180
Current year's administrative rate (before exclusions)
Measurement Year
Data collection methodology (Administrative or Hybrid)
Sampling method used (see User's Guide for entry
descriptions)
19.25%
58.84%
Minimum required sample size (MRSS) or other sample
size
335
360
Oversampling rate
Final sample size (FSS)
5%
352
5%
378
Number of numerator events by administrative data in FSS
66
229
18.75%
60.58%
Number of original sample records excluded because of
valid data errors
0
0
Number of employee/dependent medical records
excluded
0
0
0
335
62
236
0
360
216
31
88.96%
85.45%
92.46%
68.61%
63.68%
73.54%
Administrative rate on FSS
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Page 65
Access/Availability of Care
Blue Plus
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Commercial
13-17 Year Olds
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
General
Measure
Data
Initiation of
AOD
Treatment
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
26-34 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
35-64 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
65+ Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Overall Rate
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement
of AOD
Treatment
2005
A
Eligible member population (i.e. members
who meet all denominator criteria)
Numerator events by administrative data
18-25 Year Olds
169
289
131
842
12
1443
55
11
110
17
33
10
307
54
5
1
510
93
Reported rate
32.54%
6.51%
38.06%
5.88%
25.19%
7.63%
36.46%
6.41%
NA
NA
35.34%
6.44%
Lower 95% confidence interval
25.18%
2.49%
32.29%
3.00%
17.38%
2.70%
33.15%
4.70%
NA
NA
32.84%
5.14%
Upper 95% confidence interval
39.90%
10.52%
43.83%
8.77%
33.01%
12.56%
39.77%
8.13%
NA
NA
37.84%
7.75%
HEDIS 2006 (Reporting Year 2005)
Page 66
Access/Availability of Care
Blue Plus
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
13-17 Year Olds
Data Elements
General
Measure
Data
Initiation of
AOD
Treatment
18-25 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
26-34 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
35-64 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
65+ Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Overall Rate
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement
of AOD
Treatment
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
NR
NR
NR
Reported rate
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Lower 95% confidence interval
Upper 95% confidence interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Numerator events by administrative data
HEDIS 2006 (Reporting Year 2005)
Page 67
Access/Availability of Care
Blue Plus
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 10:56 AM
MSHO
13-17 Year Olds
Data Elements
General
Measure
Data
Initiation of
AOD
Treatment
18-25 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
26-34 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
35-64 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
65+ Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Overall Rate
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement
of AOD
Treatment
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
NR
Numerator events by administrative data
NR
NR
Reported rate
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Lower 95% confidence interval
Upper 95% confidence interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
Page 68
Health Plan Stability
Blue Plus
Practitioner Turnover
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
Measurement Year
Practitioner Types
Number of
Practitioners
as of
12/31/2004
Number of
Practitioners who
were not affiliated
with the plan as of
12/31/2005
Practitioner
Turnover Rate
Practitioner
Retention Rate
Primary Care
Physicians
NR
NR
Non-Physician Primary
Care Practitioners
NR
NR
HEDIS 2006 (Reporting Year 2005)
Page 69
Health Plan Stability
Blue Plus
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
Measurement Year
Product/Product Line
Years in Business
Members*
NR
NR
NR
NR
NR
NR
HMO (Total)
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
PPO (Total)
Commercial
Medicare (cost or risk)
Self-insured
Other
POS (Total)
Commercial
Medicare (cost or risk)
Self-insured
Other
NR
Total
* Total number of members in each category as of December 31, 2005
HEDIS 2006 (Reporting Year 2005)
Page 70
Health Plan Descriptive Information
Blue Plus
Enrollment by Product Line (Age & Sex)
Commercial
Measurement Year
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Data Last Refreshed:
Oct 7, 2009 10:56 AM
2005
Male
14352
59736
82248
94116
64224
38436
Member Months
Female
13092
55308
77172
89328
60924
38088
353112
31.75%
61620
51660
66072
80940
99684
333912
28.21%
72180
64872
77340
90960
118224
359976
32.36%
111372
112752
97788
62904
423576
35.79%
130452
126096
98640
62100
384816
34.60%
11076
2364
684
144
60
60
417288
35.25%
7104
1284
372
84
24
12
14388
1.29%
0
8880
0.75%
0
1112292
1183656
HEDIS 2006 (Reporting Year 2005)
Total
27444
115044
159420
183444
125148
76524
687024
29.92%
133800
116532
143412
171900
217908
783552
34.13%
241824
238848
196428
125004
802104
34.94%
18180
3648
1056
228
84
72
23268
1.01%
0
2295948
Page 71
Health Plan Descriptive Information
Blue Plus
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 10:56 AM
Medicare Advantage
Measurement Year
Male
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Member Months
Female
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 72
Health Plan Descriptive Information
Blue Plus
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 10:56 AM
MSHO
Measurement Year
Male
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Member Months
Female
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 73
Health Plan Descriptive Information
Blue Plus
Enrollment by Product Line (Age & Sex)
Medicaid
Measurement Year
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Data Last Refreshed:
Oct 7, 2009 10:56 AM
2005
Male
30927
84482
87983
85105
48896
24709
Member Months
Female
30256
81720
85109
84551
49100
30848
362102
58.98%
36033
28395
25313
27245
31598
361584
43.65%
85332
61593
48428
47648
48543
148584
24.20%
28913
22140
14062
9722
291544
35.19%
38741
24883
18082
15591
74837
12.19%
6276
5390
4830
4968
4039
2866
97297
11.74%
9858
9116
11348
14006
15266
18428
28369
4.62%
0
78022
9.42%
0
613892
828447
HEDIS 2006 (Reporting Year 2005)
Total
61183
166202
173092
169656
97996
55557
723686
50.17%
121365
89988
73741
74893
80141
440128
30.51%
67654
47023
32144
25313
172134
11.93%
16134
14506
16178
18974
19305
21294
106391
7.38%
0
1442339
Page 74